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MEDEXPRESS PHARMACY, LTD.
STD292041 Palmetto AIDS Life Support Services, Inc.
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Covered Entity Details
Entity Name
Palmetto AIDS Life Support Services, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD292041
Entity Address
2638 Two Notch Road
Suite 108
Columbia, SC 29204
Grant Number
NH25PS005150
Participating Start Date
10/1/2016
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
MEDEXPRESS PHARMACY, LTD.
Pharmacy Address
1431 W. INNES ST.
SALISBURY, NC 28144
Pharmacy Comments
Contract Details
Approval Date
10/2/2015
Contract Begin Date
10/2/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Contacts
Covered Entity Signing Official
Carmen H. Julious, CEO
(803) 779-7257
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/2/2015
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